PUBLIC NOTICE REQUEST FOR PROPOSAL UNDER A FAIR AND OPEN PROCESS RFP #14-008

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1 PUBLIC NOTICE REQUEST FOR PROPOSAL UNDER A FAIR AND OPEN PROCESS RFP # The Housing Authority of Gloucester County invites proposals for the provisions of the following type of insurance coverage for a one year policy for period beginning 5/1/14. COMPREHENSIVE GENERAL LIABILITY INSURANCE Proposals shall be received at Authority Administrative Offices 100 Pop Moylan Blvd., Deptford, New Jersey no later than: 2:00 PM WEDNESDAY APRIL 22, 2014 at which time proposals will be publicly opened and tabulated. The Housing Authority of Gloucester County is soliciting proposals through a fair and open process in accordance with N.J.S.A. 19:44A-20.4 et seq. The Housing Authority of Gloucester County reserves the right to waive informalities in proposals and/or reject all proposals. Negotiations may be conducted with offerors who submit proposals that have a reasonable chance of being selected for award. The Proposal selected shall comply with all applicable federal, state and local statutes, rules and regulations. Proposal chosen will be required to comply with P.L c.127 (affirmative action requirements), N.J.S.A. 52:32-44 (Business Registration), N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 et seq. (Contract compliance and Equal Employment Opportunities) For proposal information and proposal format, contact: SAMUEL V HUDMAN EXECUTIVE DIRECTOR HOUSING AUTHORITY OF GLOUCESTER COUNTY 100 POP MOYLAN BOULEVARD DEPTFORD, NEW JERSEY ATTN: SHERRY DITIZIO, ADMINISTRATIVE ASSISTANT The Housing Authority of Gloucester County is a fair housing provider. We do not make any preference, limitation or discrimination because of race, color, religion, sex, handicap, familial status, or national origin. The Housing Authority of the Gloucester County is an equal opportunity employer and complies with all federal and state laws, regulations and executive orders regarding employment.

2 PROPOSAL FOR COMPREHENSIVE GENERAL LIABILITY INSURANCE I (We) hereby propose to provide Comprehensive General Liability insurance for a one year term with limits of $2,500,000 covering the Housing Authority of Gloucester County. DESIGNATE PREMIUM FOR EACH PROJECT (Must breakdown premium) Gross Premium One Year Premium 63 Houses $ $ Carino Park Apts $ $ Deptford Park Apts $ $ TOTAL $ Deductible The Housing Authority of Gloucester County wishes to include an endorsement for Lead Based Paint Removal/Abatement. Please indicate whether this endorsement is available: Yes No Additional Premium if Applicable The policy will be written: 1. With blanket coverage describing the project by name and number. 2. With a Mistake in Location Clause reading as follows: "It is hereby understood and agreed that the coverage provided by this policy shall not be invalidated or affected by any inadvertent errors, omissions, or improper description of premises, or other items mentioned in this policy." 3. Providing sixty (60) days notice prior to cancellation by the company. 4. With the following endorsement: "It is agreed that the company shall not contend, in the event of any claim, that the named insured is not liable in tort by virtue of the fact that it is a governmental instrumentality or public body." 5. Attached is our certificate of insurance illustrating the amount of the bidder's Errors and Omissions coverage. Our Umbrella Liability does/does not (cross out statement that is inapplicable) cover in excess of the primary limit of the Errors and Omissions policy. This coverage will be placed with Company or Companies rated by A.M. Best. * Attached is a detailed description of the Company's dividend policy. The policy indicates how dividends are calculated and when dividends are paid. Also enclosed is a representation of the likelihood of the HAGC earning a particular dividend based on its history? Date:, Submitted By: Firm Name By: Name and Title pg. 2

3 SPECIFICATIONS FOR PERIOD BEGINNING 5/1/14 This insurance for the Housing Authority of Gloucester County shall be issued on a Comprehensive General Liability Form describing each project by name and number. The limit of liability is to be $2,500,000 per occurrence. Policy must pay all costs of defense. The policy will be written on a composite rate basis listing the total number of rental units, with the composite rate applicable to each rental unit. The community rooms and the PHA staff occupied offices shall be considered as one unit each for rating purposes. The composite rate shall be carried out three places. Quote of Guaranteed Cost Plan (annual premium for a one-year policy and/or annual installment basis and on a two year prepared basis). For purposes of comparison, all proposals will be evaluated on an annual cost basis. The policy shall include a listing of the local Housing Authority's locations, together with the number of rental units. (See attached "Statement of Locations" form.) The policy shall also include independent Contractors, Products and Completed Operations, Contractual Liability; and Personal Injury. A claims-made policy form is not acceptable. The policy is to be issued with the following endorsements attached (please check that each endorsement is included as an element of the policy): A Mistake in Location Clause reading as follows: "It is hereby understood and agreed that the coverage provided by this policy shall not be invalidated or affected by any inadvertent errors, omissions, or improper description of premises, or other items mentioned in this policy." Cancellation may not be effected by the company without sixty (60) days prior written notice to the insured. It is agreed that the company shall not contend, in the event of any claim, that the named insured is not liable in tort by virtue of the fact that it is a governmental instrumentality or public body." An Employees As Insured Endorsement providing coverage for employees. A Personal Injury Endorsement providing coverage against injury or damage to the character or reputation of a person. Broad Form Comprehensive General Liability Endorsement (I.S.O.) form or its equivalent). Companies shall have a rating by A.M. Best Company of A-, A, or A+.Provide photocopy of A.M. Best current rating with the proposal. Notice of Occurrence. "It is understood and agreed that knowledge of an occurrence or an accident by the agent, servants or employees of the insured shall not in itself constitute knowledge to the insured unless an executive officer or a partner of the named insured shall have actually received such notice from its agent, servant or employee." Each agency shall submit, along with the quotation, the names of two agency representatives and their respective home phone numbers, in order that they may be contacted in the event of an emergency. Proposals shall be on proposer's letterhead, shall be manually signed and shall be specific as to the elements of these specifications, the complete name and address of the Insurance Company proposed, as well as total specific annual premium for the insurance policy. Proposer is required to examine the specifications and risks to be covered. Failure to do so is at exclusive risk of bidder. Proposer shall certify on letterhead that proposer is familiar with HAGC loss experience and that the pg. 3

4 loss experienced was considered in formulating the proposal. Proposer shall adjust the premium should the experience factor be revised. In the event that the carrier with whom the proposer intends to place the insurance offers a dividend, the proposer will: Describe in detail the operation of the dividend plan of the carrier with whom the proposer intends to place the insurance, including how the particular carrier calculates and determines eligibility for a dividend; Detail the prior year's dividend performance of the proposed carrier; Describe the likelihood of the HAGC qualifying for any particular level of dividend plan, given the HAGC's performance history. Show the percentage of each deduction or addition listed in the schedule that it uses to present the total proposed premium (that is, for example, what is the percentage of the premium discount? The second injury fund surcharge?). Affirmative Action The Proposers must certify that it does not discriminate in the hiring or promotion of any minorities, as designated by the Equal Employment Opportunity Commission of the United States of America, or the Department of Civil Rights of the State of New Jersey; and that it does not discriminate against any person or persons on the basis of race, creed, age, color, sex, national origin, ancestry, marital status and affectional or sexual orientation or handicap. Public Records Under this RFP constitutes a public document that will be made available to the public upon request. The Proposing Agent may request to deem certain sections of its Proposal non-disclosable, as permitted by N.J.A.C. 19:9-4.2(a)4 and the New Jersey Open Public Records Act (OPRA), N.J.S.A. 47:1A-1 et seq., which determination shall be in the sole discretion of the Authority s Attorney and designated OPRA custodian of records. Each page that the Agent believes to be non-disclosable because of the applicability of an OPRA exception or for another reason (such as Federal law) shall be specifically identified with a stamp or other notation indicating that the page is to be deemed confidential and not disclosed. The Proposing Agent shall also identify the specific OPRA exception or other law or regulation that it believes to exempt the designated information from public disclosure. OPRA exceptions are listed at N.J.S.A. 47: 1A-1.1 through N.J.S.A. 47: 1A- 3. Notwithstanding any such request or determination, the Authority cannot and does not provide any assurance that any information provided to the Authority will remain confidential. All Proposing Agents are deemed to have submitted their Proposals and all information provided to the Authority will remain confidential. All Proposing Agents are deemed to have submitted their Proposals and all information within or relating to same, the understanding that the New Jersey Government Records Council or a court of competent jurisdiction may direct that any or all such information be released to the public without restriction. Division of Revenue Registration Pursuant to the terms of N.J.S.A. 52:32-44, the successful Proposing Agent is required to provide to the Authority proof of valid business registration with the Division of Revenue in the Department of the Treasury, prior to entering into a contract with the Authority. No contract shall be entered into by the Authority unless the Agent first provides proof of valid business registration. In addition, the successful Proposing Agent is required to receive from any subcontractor and/or sub-consultant it uses for goods and services under this contract, proof of valid business registration with the Division of Revenue. No subcontract shall be entered into by any contract with the Authority unless the subcontractor and/or sub-consultant first provide proof of valid business registration. Please include a copy of the Agent s Certificate of Registration with the proposal submission. pg. 4

5 Affidavit of Moral Integrity Together with the Proposal, the Agent must submit an Affidavit of Moral Integrity on the form attached hereto for review by the Authority s Director of Law. Proposer shall include: Affirmative Action Information Sheet Mandatory Equal Employment Opportunity Language Non-collusive Affidavit Certification for Contracts Grants, Loans and Cooperative Agreements (anti-lobbying certification) Affidavit of Moral Integrity Owner Disclosure Statement Evaluation Factors The Proposal will be carefully evaluated for conformance with the requirements of this RFP. Selection of a Broker will be based upon the Proposal. Respondents will be awarded a maximum of 100 points based upon the following factors: Evaluation Criteria Weight Understanding the Authority s Needs: Assigned Value 20 The Proposal shall include the firm s history in performing work similar in scope to the services required as outlined. Evaluation will include the firm s and staff s ability to support this account given the existing clients, ability to complete specific assignments in timely fashion; and compliance with professional insurance errors and omissions. Experience on Similar Projects: Assigned Value 15 Evaluation will include the agent s experience in providing the services required herein. The agent is encouraged to provide references. Credentials of Project Team: Assigned Value 15 Evaluation will include qualifications and relevant experience of key personnel, particular those involved in day-to-day management of the Authority s account. The agent should highlight experience on similar projects and comment on the availability of the staff listed. Fee for the Service: Assigned Value 50 Cost includes the premium cost of the coverage (including agent s commission), any required surcharges and any other fee(s) contemplated by the agent. Selection Following the process described above, the Housing Authority of Gloucester will make all decisions regarding selection of the finalists and the award of the contract. The decision of the Housing Authority will be considered final. pg. 5

6 EXPOSURE INFORMATION FEBRUARY 2013 Number of Dwelling Units: 1. Owned by Housing Authority of Gloucester County (Schedule Attached) 2. Section 8 Units - (Rent is subsidized by Housing Authority; Units are not owned by Housing Authority). Section 8 Programs Units 3. The Housing Authority of Gloucester County leases office space at Nancy J. Elkis Seniors Housing, 100 Pop Moylan Blvd., Deptford, New Jersey. 4. Meals are served at two Public Housing Senior Citizen Complexes by Housing Authority staff - one meal per day, seven days per week, 365 days per year. Meals are subsidized by New Jersey Dept. of Community Affairs and tenant contribution, as well as a FEMA Grant from the Federal Government. Approximately 65 tenants are on the meals program. Housing Authority staff also provides housekeeping and personal errand services. 5. Unarmed security guards are contracted at the two Senior Citizen Complexes, nights and weekends/holidays. Guards are not Housing Authority employees. Contracts - Contract Amount is approximately $100,000 per year. 6. Deptford Park Apartments is a 100 unit, 5 story building with 2 Elevators. Carino Park Apartments is a 100 unit, 8 story building with 2 Elevators. 7. Value of construction and maintenance contracts will be approximately $1,000,000 during the year All contractors and subcontractors are required to show proof of insurances before work can begin. GENERAL LIABILITY LOSS DATA Show number and total amount of losses by year for each insurance category that is included in the bid specification LOSS STATEMENT There was one claim paid in 1992 and filed approximately One slip and fall claim filed in Settled. Fatal fire in a Section 8 living unit (not owned by HAGC), August 20, 1995; received August 27, June 23, 2000, HAGC was dismissed from the lawsuit. Slip and fall claim filed January, Section 8 living unit (not owned by HAGC). Libel suit filed by tenant, which included an employee of the Authority, citing tenant s right to privacy was violated. Case settled. Storm damage to Deptford Park Settled. Elevator fall claim filed in Settled Electrical Power Surge on July 27, Settled Carino Park Roof damage due to storm, 5/01/2010. Settled Carino Park Roof damage due to wind and rain, 3/01/2011. PLEASE ATTACHED CURRENT LOSS RUNS pg. 6

7 STATEMENT OF LOCATIONS PROJECTS NJ204-1, 204-3, LOCATION ADDRESS Block & Lot Township Building Insurable Value Number Dwelling Units Construction Trilby Avenue Block 25 Lot 16 Deptford Single Fam. 1 Unit Frame No. Burke Avenue Block 177 Lot Good Intent Road Block 205 Lot Central Avenue Block 451 Lot Houston Avenue Block 174 Lot Hannold Blvd Block 460 Lot Rutgers Avenue Block 546 Lot Baylor Court Block 586 Lot Griscom Drive Block 468 Lot Sussex Avenue Block 506 Lot West First Avenue Block 11 Lot Bucknell Avenue Block 534 Lot Marion Avenue Block 50 Lot Woodbury Lake Road Block 478 Lot Third Avenue Block 333 Lot 3, Linda Lane Block 47 Lot Muhlenberg Avenue Block 547 Lot Glassboro Road Block 553 Lot 2 pg. 7

8 Stanford Avenue Block 599 Lot Lincoln Road Block 553 Lot Clifford Avenue Block 13 Lot Moore Avenue Block 28 Lot Edgewood Avenue Block 56 Lot Hamilton Avenue Block 583 Lot Montclair Avenue Block 617 Lot Riggins Avenue Block 462 Lot Craig Avenue Block 582 Lot l Lake Avenue Block 12A Lot Oak Street Block 157 Lot Walnut Street Block 139 Lot 2D Walter Drive Block 32C Lot Walter Drive Block 32B Lot Florence Avenue Block 12B Lot Rose Avenue Block 198 Lot Sixth Avenue Block 273 Lot New Brooklyn Rd Block 35 Lot 7B Jennifer Lane Block 56DD Lot Debra Court Block 56EE Lot 20 Monroe " " Black Horse Pk Block 186 Lot 6A " BLOCK 9902 LOT 5 (2010) " " pg. 8

9 Laurel Avenue Block 1F Lot Jackson Road Block 188 Lot 27A Karen Drive Block 1001 Lot Main Street Block 50D Lot One Walnut Ave. Pitman, NJ Block 55 Lot 11 Washington " " Fomal Court Block 82.1 Lot Altair Drive Block Lot Black Horse Pk. & Strand Ave. Block 96 Lot 2G Auriga Lane Block Lot Audubon Avenue Block 291 Lot 14 West Deptford " " Princeton Avenue Block 358 Lot Red Bank Avenue Block 122 Lot 19,20A Princeton Avenue Block 358 Lot Audubon Avenue Block 307 Lot 2E 54. Box 7, RD 2, Grove Avenue Block 284 Lot 6,7,7A Audubon Avenue Block 290 Lot Mantua Pike, Mantua, Block 426 Lot Woodbury Terrace Block 13 Lot Vivian Terrace Block 132B Lot Holly Drive Block 356N Lot 15 pg. 9

10 Lewis Terrace Block 132E Lot Harker Avenue Block 179D Lot Lee Avenue Block 426 Lot DuBois Avenue Block 189 Lot ' NNW of NW corner of Delsea Drive & Cooper St., Deptford Twsp. (120 Moylan Blvd., Deptford Twsp., Gloucester Co., NN 08096) (Deptford Park Apartments) Deptford 100 Onebedroom apartments & commons areas for tenants 5-Story, masonry, fire resistive, including the roof, 78,655 +/- sq. ft Chestnut Street., Williamstown, Gloucester County, NJ (Carino Park Apartments) Monroe 100 Onebedroom apartments & commons areas for tenants 8-Story, masonry, fire resistive, including the roof, 75,296 +/- sq. ft. pg. 10

11 AFFIRMATIVE ACTION INFORMATION SHEET IN ACCORDANCE WITH THE TERMS OF THE ATTACHED AGREEMENT PROPOSERS ARE REQUIRED TO SUBMIT ONE OF THE FOLLOWING FORMS RELATING TO COMPLIANCE WITH AFFIRMATIVE ACTION REGULATIONS. PLEASE COMPLETE AND RETURN THIS FORM WITH THE PROPOSAL. 1. The proposer has submitted a Federal Affirmative Action Plan Approval which consists of a valid letter from the Office of Federal Contract Compliance Programs (Good for one year of the date of letter). YES NO If yes, a photo copy of the Letter of Approval is to be submitted with the bid. (OR) 2. The proposer has submitted a Certificate of Employee Information Report pursuant to (NJAC ) and The State Treasurer has approved said report. YES NO If yes, a photo copy of the Certificate is to be submitted with the bid. (Expiration Date on Certificate) Certificate of Approval Number (OR) 3. If Proposer has already submitted Form AA-302 to the States' Affirmative Action Office, please return a copy of it with the proposal. If you are the successful proposer and have none of the above, please contact the Purchasing Department at (856) ext. 219 within five (5) days of notification of award for an Affirmative Action Employee Information Report (AA-302). This form (AA-302) must be forwarded to the States' Affirmative Action Office. The signature below certifies that one of the above forms of Affirmative Action evidence has been submitted, and all information contained above is correct to the best of my knowledge. Signed Date Signed Print Name and Title Proposers Company Name Address Telephone Number Fax Number pg. 11

12 AFFIRMATIVE ACTION STATEMENT The undersigned confirms that the Contractor agrees that in the hiring of any employees, laborers, workmen and mechanics for the performance of work under this bid that said contractor or any person on his behalf shall not be reason of race, creed, color or national origin or ancestry, discriminate against any employee in hiring who is qualified and available to perform the work to which the employment relates. The contractor shall not discriminate against any individual because of marital status or sex/age and shall comply with all statutes relating to contract on behalf of the Housing Authority of Gloucester County SIGNATURE TITLE DATE: pg. 12

13 MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq., N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICES AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: A. The Contractor or Subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will take affirmative action to ensure that such applicants are recruited and employed, and that employees are treated during employment without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such action shall include, but not limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. B. The Contractor or Subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity, or expression, disability, nationality or sex. C. The Contractor or Subcontractor, where applicable will send to each labor union or representative or workers with which it has a collective bargaining agreement or other contract or understanding a notice to be provided by the agency contracting officer advising the labor union or worker s representative of the Contractor s commitments under this act and shall post copies of the notice in conspicuous places available to employees and applicants for employment. D. The Contractor or Subcontractor where applicable agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq. as amended and supplemented from time to time and the Americans with Disabilities Act. E. The Contractor or Subcontractor agrees to make good faith efforts to employee minority and women workers consistent with the applicable county employment goals established in accordance with N.J.A.C. 17: or a binding determination of the applicable county employment goals determined by the Division, pursuant to N.J.A.C. 17: F. The Contractor or Subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity, or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. G. The Contractor or Subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personal testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. pg. 13

14 H. In conforming with the applicable employment goals, the Contractor or Subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity, or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. I. The Contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Affirmative Action Plan Approval Certificate of Employee Information Report Employee Information Report form AA302 The Contractor and its Subcontractors shall furnish such reports or other documents to the Division of Contract Compliances & EEO as may be requested by the Division from time to time in order to carry out the purposes of these regulations, and Public Agencies shall furnish such information as may be requested by the Division of Contract Compliance & EEO for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27 The parties to this contract do hereby agree that the provision of N.J.S.A. 10:5-31 et seq. dealing with discrimination in employment on Public Contracts, and the rules and regulations promulgated pursuant thereunto, are hereby made a part of this contract and are binding upon them. Submitted by: Broker Name: By: Title: Date: pg. 14

15 NON - COLLUSION AFFIDAVIT STATE OF NEW JERSEY: COUNTY OF I, of the City of In the County of and the State of, of full age, being duly sworn according to law on my oath depose and say that: I am of the firm of the bidder making the Proposal for the above-named Project, and that I executed the said Proposal with full authority so to do; that said bidder has not, directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above-named Project; and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the Housing Authority of Gloucester County relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said Project. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by. (N.J.S.A. 52:34-15). (Also type or print name of affiant under signature) Subscribed and sworn to before me this day of, 20. pg. 15

16 CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Executed this day of, 20. By: (Typed or Printed Name) (Title, if any) pg. 16

17 AFFIDAVIT OF MORAL INTEGRITY STATE OF Ss: COUNTY OF I, the (Pres., Vice Pres., Owner/Partner) of (Proposer), being first duly sworn, deposes and says: 1. That the (Proposer) wishes its Proposal to be considered with respect to the Services outlined in this RFP as follows: 2. That the (Proposer) wishes to demonstrate moral integrity in accordance with the Services to be rendered herein. 3. That in accordance with said Procedures as of the date of signing this Affidavit, neither the Proposer, or any of its Principals, Owners, Officers, or Directors are involved in any Federal, State or other Governmental Investigation concerning criminal or quasi criminal violations, except as follows: (If none, so state): 4. Proposer further states that neither the Proposer, nor any of its Principals, Owners, Officers or Directors, has ever engaged in any violation of a Federal or State Criminal Statute; or ever been indicted, convicted, or entered a plea of guilty, non vult or nolo contendere to any violation of a Federal or State Criminal Statute; or ever engaged in violation of any nature regarding work on contracts performed by it, except as follows: (If none, so state): 5. That any depository, Proposer or other agency named (herein or later) is hereby authorized to supply the Authority with any information necessary to verify any statement made in this Proposer s Affidavit of Moral Integrity. 6. That as of the date of signing this Affidavit, outstanding liens filed against this Proposer are as follows: (if none, so stated). 7. That the undersigned, being authorized to act on behalf of Proposer, certified that I am personally acquainted with the operations of said Proposer, have full knowledge of the factual basis comprising the contents of this Affidavit of Moral Integrity and that the same are true to my knowledge. 8. That if a corporation, the Proposer (is, is not) incorporated in the State of New Jersey. If not a New Jersey Corporation the Proposer (is, is not) authorized to do business in the State of New Jersey (attach Certificate of Authorization from New Jersey Secretary of State). 9. That this Affidavit of Moral Integrity is made to induce the Authority to accept a Proposer as a qualified provider of the Services and be permitted to submit a response to the RFP knowing that the said HAGC relies upon the truth of the statements herein contained. Proposer Sworn and Subscribed to Before Me This Day of 20 Signature Notary Public Title (Corporate Seal) pg. 17

18 NEW JERSEY UNIFORM ETHICS CODE FOREWORD Pursuant to N.J.S.A. 52:13D-23, the State Ethics Commission has adopted this Uniform Ethics Code to govern and guide the conduct of State officers and employees and special State officers and employees in State agencies in the Executive branch of State Government. The Uniform Ethics Code shall be the primary code of ethics for State agencies. It shall be supplemented by an agency code of ethics formulated with respect to the particular needs and problems of the agency to which said code is to apply. Each agency, in consultation with the Attorney General s Office, must review its enabling legislation to ensure that any agency specific conflicts provisions are included in any supplemental agency code. An agency code must be approved by the Commission. OWNER DISCLOSURE STATEMENT Date: The Company known as Is a: ( Check One) Partnership Sole Proprietorship Corporation Limited Liability Co. Other: The following persons are the partners and/or officers of the company (attach an additional list if needed): NAME SIGNATURE SOCIAL SECURITY NO. NAME SIGNATURE SOCIAL SECURITY NO. NAME SIGNATURE SOCIAL SECURITY NO. NAME SIGNATURE SOCIAL SECURITY NO. GENERAL TERMS AND CONDITIONS The undersigned confirms that the proposer will comply with the General Terms and Conditions required by the Housing Authority of Gloucester County. SIGNATURE DATE pg. 18